캄보디아와 라오스 보건의료인력에 대한 금연(tobacco control)관련 리더십과 연구 멘토링

Mentoring Cambodian and Lao health professionals in tobacco control leadership and research skills

L Hyder Ferry, J Job, S Knutsen, S Montgomery, F Petersen, E Rudatsikira, P Singh

Abstract

Design: 

The aim of the programme was to ultimately affect public health practice and policy in the Kingdom of Cambodia and Lao People’s Democratic Republic (Lao PDR) by training key health professionals to conduct tobacco control research.

Setting:

Encouraged by the World Health Organization’s Framework Convention on Tobacco Control, a global partnership formed to build effective leadership to develop and guide national tobacco control agendas. The partners were the Ministries of Health (Cambodia and Lao PDR), non-government organisations (Adventist Development and Relief Agency in Cambodia and Laos) and an academic institution (Loma Linda University, Loma Linda, California, USA).

Subjects: 

16 health professionals, 10 from Cambodia and 6 from Lao PDR, were selected by local advisory committees to enter a two-year, intensive tobacco research graduate certificate and research training programme.

Intervention: 

We developed a “Global Tobacco Control Methods” (GTCM) 28 unit certificate programme that was offered in five sessions from September 2003 to September 2005 at the National Institute of Public Health, Phnom Penh, Cambodia. As part of their coursework, the 16 trainees actively participated in the development and implementation of two research projects. 

In the first project, “Healthy Doc Healthy Patient” (HDHP), trainees adapted an existing, self-administered questionnaire designed to assess health practices and beliefs of medical students in Cambodia and Lao PDR. 

The second project involved the design of a national prevalence of tobacco use and health beliefs study in Cambodia using a multi-stage, cluster sample method. Trainees were sponsored to attend and present at international tobacco control conferences to enhance their awareness of the tobacco epidemic.

Results: 

As of September 2005, 14 trainees (8 from Cambodia and 6 from Lao PDR) completed the courses in the GTCM certificate programme. The HDHP study sampled four medical school classes (years 3, 4, 5 and 6) in both Cambodia (n  =  330, 71.1% response rate) and Lao PDR (n  =  386, 87.3% response rate). As part of the Cambodian adult tobacco prevalence study in Cambodia, 13 988 adults (ages ⩾ 18 years) were interviewed from all 22 provinces during the summer of 2005. 

Over the two years, more than half of the trainees participated substantially in local and regional tobacco control and research activities. Programme challenges included the trainees’ limited English language and computer proficiency skills, both of which improved during the two years.

Conclusions: 

With the successful completion of the certificate programme, the remaining two years of the grant will be used to prepare the trainees for positions of leadership within their Ministries of Health and other agencies to implement effective tobacco control policies based on locally-derived research findings.

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Capacity building and mentoring plans

The selection of Cambodian and Lao trainees

After forming local Steering Committees, the members selected the most suitable candidates from government and non-government organisations (NGOs) who would most likely utilise the mentoring and training to improve the tobacco control agenda in their respective countries. 

The candidates had to: 

(1) apply for graduate training at Loma Linda University School of Public Health (LLU SPH), 

(2) demonstrate English proficiency, and 

(3) obtain permission from their employers to participate in a 28 unit graduate level certificate programme from LLU on a part-time basis (2003–2005).

Sixteen positions were made available for full scholarship in the mentoring programme. Ten trainees from Cambodia and six trainees from Lao PDR were accepted into the newly designed “Global Tobacco Control Methods” certificate programme.

Global Tobacco Control Methods certificate programme

The LLU SPH application process required the Asian students to meet US graduate application standards. 

모든 수업자료는 영어로 제공됨.

All course materials and lectures in Asia were given in English for two reasons: 

to improve communication skills of trainees with international English speaking colleagues, and 

to reduce the burden of having to translate into two languages simultaneously (Khmer for Cambodians and Lao’s national language).

RESULTS

Trainee participation

The evaluations by the trainees indicated that they had never been trained to this level of sophistication in the courses we provided, especially in the ethics of medical research. They stated that they were able to use the skills immediately in their work situations and that it enhanced their career performance. Many were challenged by their limited English skills initially, but developed progressive proficiency with each intensive teaching session.

After the second teaching session, three of the Cambodian trainees discontinued the programme. 

One trainee declined because she received a full scholarship to complete an MPH in Australia. 

The other two discontinued because of lack of support from the employee’s supervisors to release them to attend the sessions. Three other candidates were recruited to fill these positions and they remained until the completion of the certificate programme.

Three of our Cambodian trainees work in the office of tobacco control in the National Center for Health Promotion. There is no centralised equivalent of the Office of Smoking or Heath in Lao PDR, but two of our trainees are responsible for policy and anti-tobacco mass communication topics.

Challenges and limitations

Our initial pioneering partnership of government, non-government agencies and academic institutions required frequent communication and negotiation to establish effective working relationships. Clearly each entity had to balance the differences in their agendas, but the results have demonstrated how working together for a common goal can create synergy. The expertise, support and authority required to produce quality tobacco control research leadership is a shared responsibility.

Few of the candidates scored above the minimum required English language proficiency scores at the onset of the training. This constraint was minimised in the classroom by ready access to dictionaries, and frequent clarification of idioms or western concepts.

Computer knowledge, typing skills and internet skills among trainees was not uniform. None of the trainees had reliable electronic mail access, except at work, where often it was shared with several other employees. We purchased internet accounts for the trainees in some cases so they would be able to submit assignments by email to the course instructors, and stay in touch with the ADRA course coordinator.

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Tob Control. 2006 Jun;15 Suppl 1:i42-7.

Mentoring Cambodian and Lao health professionals in tobacco control leadership and research skills.

Ferry LH1, Job J, Knutsen S, Montgomery S, Petersen F, Rudatsikira E, Singh P.

Author information

Abstract

DESIGN:

The aim of the programme was to ultimately affect public health practice and policy in the Kingdom of Cambodia and Lao People's Democratic Republic (Lao PDR) by training key health professionals to conduct tobacco control research.

SETTING:

Encouraged by the World Health Organization's Framework Convention on Tobacco Control, a global partnership formed to build effectiveleadership to develop and guide national tobacco control agendas. The partners were the Ministries of Health (Cambodia and Lao PDR), non-government organisations (Adventist Development and Relief Agency in Cambodia and Laos) and an academic institution (Loma Linda University, Loma Linda, California, USA).

SUBJECTS:

16 health professionals, 10 from Cambodia and 6 from Lao PDR, were selected by local advisory committees to enter a two-year, intensive tobacco research graduate certificate and research training programme.

INTERVENTION:

We developed a "Global Tobacco Control Methods" (GTCM) 28 unit certificate programme that was offered in five sessions from September 2003 to September 2005 at the National Institute of Public Health, Phnom Penh, Cambodia. As part of their coursework, the 16 trainees actively participated in the development and implementation of two research projects. In the first project, "Healthy Doc Healthy Patient" (HDHP), trainees adapted an existing, self-administered questionnaire designed to assess health practices and beliefs of medical students in Cambodia andLao PDR. The second project involved the design of a national prevalence of tobacco use and health beliefs study in Cambodia using a multi-stage, cluster sample method. Trainees were sponsored to attend and present at international tobacco control conferences to enhance their awareness of the tobacco epidemic.

RESULTS:

As of September 2005, 14 trainees (8 from Cambodia and 6 from Lao PDR) completed the courses in the GTCM certificate programme. The HDHP study sampled four medical school classes (years 3, 4, 5 and 6) in both Cambodia (n = 330, 71.1% response rate) and Lao PDR (n = 386, 87.3% response rate). As part of the Cambodian adult tobacco prevalence study in Cambodia, 13,988 adults (ages > or = 18 years) were interviewed from all 22 provinces during the summer of 2005. Over the two years, more than half of the trainees participated substantially in local and regionaltobacco control and research activities. Programme challenges included the trainees' limited English language and computer proficiency skills, both of which improved during the two years.

CONCLUSIONS:

With the successful completion of the certificate programme, the remaining two years of the grant will be used to prepare the trainees for positions of leadership within their Ministries of Health and other agencies to implement effective tobacco control policies based on locally-derived research findings.

PMID:

 

16723675

 

[PubMed - indexed for MEDLINE] 

PMCID:

 

PMC2563552

 

Free PMC Article